Novel cost-effective approaches to the treatment of community-acquired infections.
OBJECTIVE
To review approaches to the diagnosis and treatment of patients with community-acquired infections.


BACKGROUND
Dramatic changes in the antibiotic susceptibility of pathogens commonly associated with community-acquired infections have occurred during the past decade.


CONCLUSIONS
Changes in the antibiotic sensitivity profile of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis that have occurred over the past several years have required modifications in empiric antibiotic selections for infections due to these pathogens. The most profound changes have occurred with S. pneumoniae, which has shown significant resistance to beta-lactams by means of alteration of one or more of the five important penicillin-binding proteins. Many of these organisms have become resistant to other classes of antibiotics; some are sensitive only to vancomycin. H. influenzae and M. catarrhalis have developed resistance primarily by production of beta-lactamase.


CONCLUSIONS
The antibiotic selection process for the treatment of community-acquired pneumonia relates to the site of infection and, in many cases, the in vitro sensitivity testing results or known patterns in a given geographic area.
Schwarzmann
S W
SW
School of Medicine, Emory University, Atlanta, GA, USA.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001428:Bacterial Vaccines / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D004352:Drug Resistance, Microbial; D006193:Haemophilus influenzae / Q000187:drug effects; D006801:Humans; D001936:Moraxella catarrhalis / Q000187:drug effects; D010349:Patient Compliance; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D013296:Streptococcus pneumoniae / Q000187:drug effects
D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines